糖尿病の経過中に両側の母趾痛を来し鑑別困難な1例

Difficult Diagnosis of Bilateral First Metatarsophalangeal Joint Arthralgia in Type1 Diabetes Mellitus. Case Report

　51歳の男性が緩徐発症1型糖尿病の発症後に片側の母趾関節痛を来し，MRI画像で骨髄浮腫および滑膜炎の所見を呈した．1年後に単純X線像は骨びらん像を呈した．さらに1年後，患者は反対側の母趾痛を来した．痛風，関節リウマチなどの膠原病，Charcot関節，Freiberg病，変形性関節症(強剛母趾)などの鑑別が必要であったが確定診断には至っておらず，骨生検などを検討中であり注意深く観察中である．

　A fifty one-year-old man suffered first metatarsophalangeal (MTP) joint pain after the onset of slowly progressive insulin-dependent diabetes mellitus.　Magnetic resonance imaging initially showed bone edema and active synovitis.　One year later, the first MTP joint showed bone erosion, and 2 years later, the patient suffered first MTP joint pain on the opposite foot.　We had difficulty diagnosing this disease and needed to rule out gout, rheumatoid arthritis, and other connective tissue diseases, including septic joint, Charcot joint, Freiberg disease, and osteoarthritis (hallux rigidus).　We are considering bone biopsy and we must treat the changes carefully.